Background
Methods
Study design, data source and population studied
Exposure
Main outcome measures
Statistical analyses
Testing for a cohort effect
Subgroup and sensitivity analyses
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Model 1: adjusted for key potential confounders available for the entire study period including maternal age, country of origin, educational attainment, mother and father’s gross income, marital status, infant birthplace, infant birth weight, birth year and history of pregnancy loss plus smoking status (1991–2010, cohort n = 50,880).
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Model 2: adjusted for Model 1 plus comorbidities in the second live birth including hypertension, eclampsia, preeclampsia, fetal distress and gestational diabetes (1994–2010, cohort n = 45,979).
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Model 3: adjusted for Model 2 plus BMI (2004–2010, cohort n = 22,672).
Results
Characteristics of the study population
First CS | |||
---|---|---|---|
Elective repeat CS | Trial of labour after CS | Total | |
Maternal characteristics of the second delivery | |||
Age in years, <20 | 24 (0%) | 133 (0%) | 157 (0%) |
20–25 | 1,920 (9%) | 5,655 (14%) | 7,575 (12%) |
26–30 | 6,997 (33%) | 16,582 (41%) | 23,579 (38%) |
31–35 | 8,096 (39%) | 14,349 (35%) | 22,445 (36%) |
36–40 | 3,423 (16%) | 3,660 (9%) | 7,083 (11%) |
41+ | 481 (2%) | 306 (1%) | 787 (1%) |
Origin, Denmark | 18,685 (89%) | 36,757 (90%) | 55,442 (90%) |
Other | 2,183 (10%) | 3,834 (9%) | 6,017 (10%) |
Unknown | 73 (0%) | 94 (0%) | 167 (0%) |
Marital status, Married | 7,514 (36%) | 13,567 (33%) | 21,081 (34%) |
Divorced/separated/widowed | 573 (3%) | 748 (2%) | 1,321 (2%) |
Co-habiting | 12,633 (60%) | 25,917 (64%) | 38,550 (63%) |
Unknown | 221 (1%) | 453 (1%) | 674 (1%) |
Educational attainment, Primary | 4,496 (21%) | 9,817 (24%) | 14,313 (23%) |
High school | 10,193 (49%) | 20,057 (49%) | 30,250 (49%) |
Third level degree | 4,183 (20%) | 7,432 (18%) | 11,615 (19%) |
Masters/PhD | 1,447 (7%) | 2,183 (5%) | 3,630 (6%) |
Unknown | 622 (3%) | 1,196 (3%) | 1,818 (3%) |
Mother’s gross income (quartiles), 25 | 2,997 (14%) | 5,766 (14%) | 8,763 (14%) |
50 | 3,954 (19%) | 7,789 (19%) | 11,743 (19%) |
75 | 9,513 (45%) | 19,299 (47%) | 28,812 (47%) |
100 | 4,339 (21%) | 7,514 (18%) | 11,853 (19%) |
Unknown | 138 (1%) | 317 (1%) | 455 (1%) |
aSmoker, No | 14,387 (82%) | 25,814 (78%) | 40,201 (79%) |
Yes | 2,665 (15%) | 6,733 (20%) | 9,398 (18%) |
Unknown | 566 (3%) | 715 (2%) | 1,281 (3%) |
Characteristic of the second delivery | |||
Father’s gross income (quartiles), 25 | 1,497 (7%) | 3,156 (8%) | 4,653 (8%) |
50 | 2,264 (11%) | 4,765 (12%) | 7,029 (11%) |
75 | 6,266 (30%) | 12,702 (31%) | 18,968 (31%) |
100 | 10,582 (51%) | 19,412 (48%) | 29,994 (49%) |
Unknown | 332 (2%) | 650 (2%) | 982 (2%) |
bBMI (kg/m2) <18.5 | 523 (5%) | 638 (5%) | 1,161 (5%) |
18.5–25 | 5,849 (55%) | 7,412 (62%) | 13,261 (58%) |
26–30 | 2,198 (21%) | 2,092 (18%) | 4,290 (19%) |
31–35 | 1,064 (10%) | 753 (6%) | 1,817 (8%) |
36+ | 643 (6%) | 347 (3%) | 990 (4%) |
Unknown | 439 (4%) | 714 (6%) | 1,153 (5%) |
cPreeclampsia, eclampsia | 342 (2%) | 613 (2%) | 955 (2%) |
dFetal distress | 98 (1%) | 6,358 (22%) | 6,456 (14%) |
eGestational diabetes | 645 (4%) | 504 (2%) | 1,149 (3%) |
fHypertension | 203 (1%) | 337 (1%) | 540 (1%) |
Previous stillbirth | 494 (2%) | 371 (1%) | 865 (1%) |
Previous miscarriage | 3,288 (16%) | 6,675 (16%) | 9,963 (16%) |
Previous ectopic pregnancy | 863 (4%) | 1,681 (4%) | 2,544 (4%) |
Infant characteristics of the second delivery | First CS | |
---|---|---|
Elective repeat CS | Trial of labour after CS | |
Infant sex, male | 10,845 (52%) | 20,472 (50%) |
Female | 10,096 (48%) | 20,213 (50%) |
Birthplace, Capital (Copenhagen) | 3,809 (18%) | 6,352 (16%) |
Capital suburbs | 2,224 (11%) | 5,409 (13%) |
Provincial city | 2,641 (13%) | 4,852 (12%) |
Provincial town | 5,846 (28%) | 11,184 (27%) |
Rural area | 6,369 (30%) | 12,807 (31%) |
Unknown | 52 (0%) | 81 (0%) |
Apgar score <7 at 5 min | 190 (1%) | 1,016 (3%) |
Birth weight (g), <2,500 | 1,440 (7%) | 6,165 (15%) |
2500–3500 | 8,179 (39%) | 18,805 (46%) |
3500–4500 | 9,556 (46%) | 14,358 (35%) |
4500+ | 1,569 (7%) | 1,129 (3%) |
Unknown | 197 (1%) | 228 (1%) |
Gestational age, weeks, mean ± standard deviation | 39.06 (1.2) | 40.28 (1.3) |
Admission to NICUa
| 645 (5%) | 414 (3%) |
Neonatal death, early neonatal death, late neonatal death and infant death
Mode of delivery 1st and 2nd birth (Number of events) | Neonatal death (≤28 days) n = 95 | |
OR (95% CI) |
aModel 1 AOR (95% CI) | |
CS – ERCS (n = 21) | Ref | Ref |
CS – TOLAC (n = 74) | 1.82 (1.12, 2.95) | 1.87 (1.12, 3.12) |
Mode of delivery 1st and 2nd birth (Number of events) | Early neonatal death (≤7 days) n = 86 | |
OR (95% CI) |
aModel 1 AOR (95% CI) | |
CS – ERCS (n = 18) | Ref | Ref |
CS – TOLAC (n = 68) | 1.95 (1.16, 3.27) | 2.06 (1.19, 3.56) |
Mode of delivery 1st and 2nd birth (Number of events) | Late neonatal death (>7 days, ≤28 days) n = 9 | |
OR (95% CI) |
aModel 1 AOR (95% CI) | |
CS – ERCS (n = 3) | Ref | Ref |
CS – TOLAC (n = 6) | 1.03 (0.26, 4.12) | 0.97 (0.22, 4.32) |
Mode of delivery 1st and 2nd birth (Number of events) | Infant death (≤365 days) n = 171 | |
OR (95% CI) |
aModel 1 AOR (95% CI) | |
CS – ERCS (n = 49) | Ref | Ref |
CS – TOLAC (n = 122) | 1.28 (0.92, 1.79) | 1.12 (0.79, 1.59) |
Testing for a cohort effect
Mode of delivery 1st and 2nd births | Neonatal death (≤28 days) n = 95 in entire cohort 1982–2010 | ||
aModel 1 AOR (95% CI) (35 deaths) |
bModel 2 AOR (95% CI) (34 deaths) |
cModel 3 AOR (95% CI) (26 deaths) | |
CS – ERCS | Ref | Ref | Ref |
CS – TOLAC | 3.89 (1.33, 11.39) | 2.87 (0.85, 9.70) | 1.01 (0.44, 2.31) |
Mode of delivery 1st and 2nd birth | Infant death (≤365 days) n = 171 in entire cohort 1982–2010 | ||
aModel 1 AOR (95% CI) (69 deaths) |
bModel 2 AOR (95% CI) (64 deaths) |
cModel 3 AOR (95% CI) (38 deaths) | |
CS – ERCS | Ref | Ref | Ref |
CS – TOLAC | 1.24 (0.70, 2.21) | 1.37 (0.70, 2.69) | 0.81 (0.42, 1.59) |